
DOI: 10.1055/s-0040-1701555
Outcomes in Schatzker Type 5 and Type 6 Tibial Plateau Fractures Treated with Ilizarov External Fixator: Follow-up in 30 Patients

Abstract
Introduction Fractures of the proximal tibia, particularly those that extend into the knee joint, are serious injuries that frequently result in functional impairment. Complications include infection, compartment syndrome, stiffness, skin loss, and possible amputation. These can be minimized using the Ilizarov external fixator which allows early weight bearing, minimal soft tissue injury, and a multiaxial stable fixation.
Materials and Methods A total of 30 patients with open/closed Schatzker type 5 and 6 tibial plateau fractures were studied for outcome following surgery and implant removal using the modified Hohl and Luck criteria which include functional (extensor lag, valgus or varus instability, knee range of movement, walking distance and pain) and radiological parameters (valgus/varus deformity, depression of articular surface, and osteoarthritis).
Results In our study, out of 30 patients 53.3% patients had an excellent outcome functionally, whereas 23.3% had a good outcome, 13.3% fair, and 10% had a poor outcome. Radiologically, 46.6% had an excellent outcome, 40% had a good outcome, and 13.3% had a fair outcome. All the patients achieved union with a mean time of 23.9 weeks. Common complication was pin tract infection in 13.3% patients. In total, 60% of the patients could be mobilized immediately with the remaining mobilized within 1 to 4 weeks.
Conclusion Most patients had an excellent to good functional or radiological outcome once the implant was removed. Weight bearing could be started immediately in most cases with minimal complications encountered in few patients like pin tract infection, deep venous thrombosis, and osteomyelitis.
Publikationsverlauf
Publikationsdatum:
07. Februar 2020 (online)
© .
Thieme Medical and Scientific Publishers Private Ltd
A-12, Second Floor, Sector -2, NOIDA -201301, India
References
- 1 Gustilo RB. Fractures of the Tibial plateau. In: Gustilo RB, Kyle R, Templeman D. eds. Fractures and Dislocations. St. Louis, MO: C.V. Mosby; 1993: 945
- 2 Honkonen SE, Järvinen MJ. Classification of fractures of the tibial condyles. J Bone Joint Surg Br 1992; 74 (06) 840-847
- 3 Koval KJ, Helfet DL. Tibial plateau fractures: evaluation and treatment. J Am Acad Orthop Surg 1995; 3 (02) 86-94
- 4 Waddell JP, Johnston DW, Neidre A. Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods. J Trauma 1981; 21 (05) 376-381
- 5 Ramos T, Ekholm C, Eriksson BI, Karlsson J, Nistor L. The Ilizarov external fixator—a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord 2013; 14: 11-23
- 6 Jensen DB, Rude C, Duus BR. Arne B-N. Tibial plateau fractures. A comparison of conservative and surgical treatment. Bone Joint Surg Br 1990; 72 (01) 49-52
- 7 Raikin S, Froimson MI. Combined limited internal fixation with circular frame external fixation of intra-articular tibial fractures. Orthopedics 1999; 22 (11) 1019-1025
- 8 Schatzker J. Fractures of the tibial plateau. In: Schatzker J, Tile M. eds. Rationale of Operative Fracture Care. Berlin: Springer-Verlag; 1987: 279-295
- 9 Schatzker J. Tibial plateau fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG. eds. Skeletal Trauma. Philadelphia, PA: W.B. Saunders; 1992: 1745-1770
- 10 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 1979; (138) 94-104
- 11 Hohl M, Luck JV. Fractures of the tibial condyle; a clinical and experimental study. J Bone Joint Surg Am 1956; 38-A (05) 1001-1018
- 12 Apley AG. Fractures of the lateral tibial condyle treated by skeletal traction and early mobilisation: a review of sixty cases with special reference to the long-term results. J Bone Joint Surg Br 1956; 38-B (03) 699-708
- 13 Apley AG. Fractures of the tibial plateau. Orthop Clin North Am 1979; 10 (01) 61-74
- 14 Gausewitz S, Hohl M. The significance of early motion in the treatment of tibial plateau fractures. Clin Orthop Relat Res 1986; (202) 135-138
- 15 Sarmiento A, Kinman PB, Latta LL, Eng P. Fractures of the proximal tibia and tibial condyles: a clinical and laboratory comparative study. Clin Orthop Relat Res 1979; (145) 136-145
- 16 Scotland T, Wardlaw D. The use of cast-bracing as treatment for fractures of the tibial plateau. J Bone Joint Surg Br 1981; 63B (04) 575-578
- 17 Segal D, Mallik AR, Wetzler MJ, Franchi AV, Whitelaw GP. Early weight bearing of lateral tibial plateau fractures. Clin Orthop Relat Res 1993; (294) 232-237
- 18 Ali AM, Burton M, Hashmi M, Saleh M. Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system. J Bone Joint Surg Br 2003; 85 (05) 691-699
- 19 Keightley AJ, Nawaz SZ, Jacob JT, Unnithan A, Elliott DS, Khalil A. Ilizarov management of Schatzker IV to VI fractures of the tibial plateau. Bone Joint J 2015; 97-B: 1693-1697
- 20 Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg Br 2005; 87 (05) 716-719
- 21 Checketts RG, Otterburn M, Mac Eachern AG. Pin track infection; definition, incidence and prevention. Int J Orthop Trauma 1993; 3 Suppl 3 16-18
- 22 Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg 1996; 78 (05) 710-717
- 23 Stokel EA, Sadasivan KK. Tibial plateau fractures: standardized evaluation of operative results. Orthopedics 1991; 14 (03) 263-270
- 24 Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB. Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma 1992; 6 (01) 78-86
- 25 Burri C, Bartzke G, Coldewey J, Muggler E. Fractures of the tibial plateau. Clin Orthop Relat Res 1979; (138) 84-93
- 26 Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1987; 1 (02) 97-119
- 27 Boszotta H, Helperstorfer W, Kölndorfer G, Prünner K. Long-term results of surgical management of tibial head fractures [in German]. Aktuelle Traumatol 1993; 23 (04) 178-182
- 28 Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994; 23 (02) 149-154
- 29 Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004; 18 (10) 649-657
- 30 Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Röder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma 2008; 22 (10) 673-679
- 31 Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21 (01) 5-10
- 32 Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 2005; 19 (07) 448-455, discussion 456
- 33 Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem?. J Orthop Trauma 2003; 17 (07) 503-507
- 34 Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 2007; 63 (05) 1043-1053
- 35 Yu Z, Zheng L, Zhang Y, Li J, Ma B. Functional and radiological evaluations of high-energy tibial plateau fractures treated with double-buttress plate fixation. Eur J Med Res 2009; 14 (05) 200-205
- 36 Lee JA, Papadakis SA, Moon C, Zalavras CG. Tibial plateau fractures treated with the less invasive stabilisation system. Int Orthop 2007; 31 (03) 415-418
- 37 Oh CW, Oh JK, Kyung HS. et al. Double plating of unstable proximal tibial fractures using minimally invasive percutaneous osteosynthesis technique. Acta Orthop 2006; 77 (03) 524-530
- 38 El Barbary H, Abdel Ghani H, Misbah H, Salem K. Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int Orthop 2005; 29 (03) 182-185
- 39 Zecher SB, Danziger MB, Segal D, Foster T, Whitelaw GP, Covall DJ. Treatment of high-energy proximal tibial fractures using the Monticelli-Spinelli external fixator: a preliminary report. Am J Orthop 1996; 25 (01) 49-54
- 40 Debnath UK, Jha DK, Pujari PK. Results of ring (Ilizarov) fixator in high energy Schatzker type VI fractures of proximal tibia. J Clin Orthop Trauma 2018; 9 (02) 186-191
- 41 Taşkesen A, Demirkale İ, Okkaoğlu MC, Özdemir M, Bilgili MG, Altay M. Intraobserver and interobserver reliability assessment of tibial plateau fracture classification systems. Eklem Hastalik Cerrahisi 2017; 28 (03) 177-181